Health Survey Research Articles

A cross-comparative analysis of child poverty across sub-Saharan Africa: the case of Francophone and Anglophone African states

PurposeThe institutional structures established by French and British colonists continue to shape the socio-economic landscape of sub-Saharan Africa, potentially contributing to the unequal distribution of child poverty. This study, therefore, has significant relevance as it aims to estimate child poverty disparities within the context of colonial origins in Francophone and Anglophone African countries.Design/methodology/approachThis study utilised data from the Demographic and Health Surveys (DHS) conducted between 2000 and 2019 involving 22 sub-Saharan African states. A rights-based framework was applied based on the SDG-updated Gordon et al. (2003) methodology to measure child poverty. We then compared child poverty disparities between colonial origins using one-way ANOVA tests and risk ratios to quantify the magnitude of these differences.FindingsCritically high estimates of sanitation and housing poverty (above 70% prevalence) were observed in the two colonial settings. Children in Francophone states were 1.4 times (RR = 1.4; 95% CI: 1.1–1.8) more likely to experience higher risks of low medical access, almost twice as likely to experience low vaccine uptake (risk ratios-RR = 1.8; 95% CI: 1.2–2.8) or no formal education (RR = 1.7; 95% CI: 1.1–2.5). All other dimensions were equal between colonial origins.Research limitations/implicationsDue to its cross-comparative approach, this study is restricted in making conclusive inferences regarding the causal relationship between colonialism and health/education poverty. Also, given the limited number of countries, particularly Anglophone countries, our sample may not fully represent all French and British ex-colonies. As a follow-up to this study, we intend to repeat this analysis using the harmonised Multiple Indicator Cluster (MIC) surveys, providing a larger number of countries.Originality/valueDespite similar household poverty levels in both colonial settings, Francophone states had lower access to health and education services than Anglophone states. These findings indicate deeper systemic issues that may be rooted in the historical governance styles of centralisation. More effective decentralisation of healthcare and education services in Francophone countries and improved government commitment to addressing household poverty throughout sub-Saharan Africa are imperative.

Geographical health inequalities in India: the impact of the COVID-19 pandemic on healthcare access and healthcare inequality.

With an emphasis on spatial health disparities, this study examines how COVID-19 has affected healthcare access and inequality in India. The study developed the Healthcare Access Index (HAI) and Healthcare Inequality Index (HII) to assess the pandemic's effects on healthcare. The study addresses spatial health disparities in healthcare access and inequality, filling gaps in the literature. The final aim of the study is to offer policy suggestions to lessen healthcare inequities in India, particularly in the context of COVID-19. The study incorporates secondary data from publicly accessible databases such as the National Family Health Survey, Niti-Ayog and Indian Census databases and employs a quantitative research design. The impact of the COVID-19 pandemic on healthcare access and healthcare inequality in India is examined using the HAI and the HII. The five dimensions of healthcare access - availability, accessibility, accommodation, cost and acceptability - were used in developing the HAI. The study uses a panel data analysis methodology to examine the HAI and HII scores for 19 states over the pre-COVID-19 (2015) and post-COVID-19 (2020) periods. In order to investigate the connection between healthcare access, healthcare inequality and the COVID-19 pandemic, the analysis employs statistical tests such as descriptive statistics, correlation analysis, factor analysis and visualization analysis. According to the study, COVID-19 impacted healthcare access and inequality in India, with notable regional inequalities between states. The pandemic has increased healthcare disparities by widening the gap between states with high and low HII ratings. Healthcare access is closely tied to healthcare inequality, with lower levels of access being associated with more significant levels of inequality. The report advises governmental initiatives to lessen healthcare disparities in India, such as raising healthcare spending, strengthening healthcare services in underperforming states and enhancing healthcare infrastructure. For Indian healthcare authorities and practitioners, the study has significant ramifications. In light of the COVID-19 pandemic, there has been a main focus on addressing geographic gaps in healthcare access and inequality. The report suggests upgrading transportation infrastructure, lowering out-of-pocket costs, increasing health insurance coverage and enhancing healthcare infrastructure and services in underperforming states. The HAI and the HII are tools that policymakers can use to identify states needing immediate attention and appropriately spend resources. These doable recommendations provide a framework for lowering healthcare disparities in India and enhancing healthcare outcomes for all communities. The study's originality resides in establishing the HAI and HII indices, using panel data analysis and assessing healthcare inequality regarding geographic disparities. Policy choices targeted at lowering healthcare disparities and enhancing healthcare outcomes for all people in India can be informed by the study's practical consequences.

Narrative nursing for negative emotions in patients with acute pancreatitis: Based on model construction and application

BACKGROUND Acute pancreatitis (AP), as a common acute abdomen disease, has a high incidence rate worldwide and is often accompanied by severe complications. Negative emotions lead to increased secretion of stress hormones, elevated blood sugar levels, and enhanced insulin resistance, which in turn increases the risk of AP and significantly affects the patient's quality of life. Therefore, exploring the intervention effects of narrative nursing programs on the negative emotions of patients with AP is not only helpful in alleviating psychological stress and improving quality of life but also has significant implications for improving disease outcomes and prognosis. AIM To construct a narrative nursing model for negative emotions in patients with AP and verify its efficacy in application. METHODS Through Delphi expert consultation, a narrative nursing model for negative emotions in patients with AP was constructed. A non-randomized quasi-experimental study design was used in this study. A total of 92 patients with AP with negative emotions admitted to a tertiary hospital in Nantong City of Jiangsu Province, China from September 2022 to August 2023 were recruited by convenience sampling, among whom 46 patients admitted from September 2022 to February 2023 were included in the observation group, and 46 patients from March to August 2023 were selected as control group. The observation group received narrative nursing plan, while the control group was given with routine nursing. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), positive and negative affect scale (PANAS), caring behavior scale, patient satisfaction scale and 36-item short form health survey questionnaire (SF-36) were used to evaluate their emotions, satisfaction and caring behaviors in the two groups on the day of discharge, 1-and 3-month following discharge. RESULTS According to the inclusion and exclusion criteria, a total of 45 cases in the intervention group and 44 cases in the control group eventually recruited and completed in the study. On the day of discharge, the intervention group showed significantly lower scores of SAS, SDS and negative emotion (28.57 ± 4.52 vs 17.4 ± 4.44, P < 0.001), whereas evidently higher outcomes in the positive emotion score, Caring behavior scale score and satisfaction score compared to the control group (P < 0.05). Repeated measurement analysis of variance showed that significant between-group differences were found in time effect, inter-group effect and interaction effect of SAS and PANAS scores as well as in time effect and inter-group effect of SF-36 scores (P < 0.05); the SF-36 scores of two groups at 3 months after discharge were higher than those at 1 month after discharge (P < 0.05). CONCLUSION The application of narrative nursing protocols has demonstrated significant effectiveness in alleviating anxiety, ameliorating negative emotions, and enhancing satisfaction among patients with AP.

Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages by Social Determinants of Health

ImportanceCardiovascular-kidney-metabolic (CKM) syndrome—a novel, multistage, multisystem disorder as defined by the American Heart Association—is highly prevalent in the US. However, the prevalence of CKM stages by social determinants of health (SDOH) remains unclear.ObjectiveTo investigate whether the prevalence of CKM stages varies by SDOH in US adults.Design, Setting, and ParticipantsThis cross-sectional study used data from the National Health and Nutrition Examination Survey (1999-2018) and included a nationally representative sample of adults aged 30 to 79 years through complex, multistage probability sampling. Data were analyzed from April 1 to June 15, 2024.ExposuresThe exposures included 5 CKM stages (ie, stages 0-4) reflecting progressive pathophysiology, with advanced (stages 3 or 4) and nonadvanced (stages 0, 1, or 2) disease. CKM stages were defined based on risk factors for metabolic syndrome, cardiovascular disease, and chronic kidney disease.Main Outcome and MeasuresThe main outcome was the age-standardized prevalence of CKM stages and advanced CKM stages across SDOH, including education, marital status, family income, food security, health insurance, employment, home ownership, and health care access.ResultsAmong 29 722 participants (weighted mean [SE] age, 50.8 [0.1] years; weighted 50.7% male), the age-standardized prevalence of CKM stages 0 to 4 was 13.6% (95% CI, 13.0%-14.3%), 29.9% (95% CI, 29.1%-30.7%), 43.7% (95% CI, 42.9%-44.5%), 4.7% (95% CI, 4.4%-5.0%), and 8.1% (95% CI, 7.6%-8.5%), respectively. Significant differences were observed in the prevalence of CKM stages across all unfavorable SDOH of interest compared with their favorable counterparts, with unemployment (18.8% [95% CI, 17.7%-20.1%] vs 11.4% [95% CI, 11.0%-11.9%]), low family income (16.1% [95% CI, 15.4%-16.8%] vs 10.1% [95% CI, 9.5%-10.7%]), and food insecurity (18.3% [95% CI, 17.1%-19.6%] vs 11.7% [95% CI, 11.2%-12.2%]) associated with an increased likelihood of advanced CKM stages. Participants with 2 or more unfavorable SDOH were more likely to have advanced CKM stages (age-standardized prevalence, 15.8% [95% CI, 15.2%-16.5%] vs 10.5% [95% CI, 9.9%-11.1%] with <2 unfavorable SDOH). Living in a rented home (15.9% [95% CI, 14.7%-17.0%] vs 9.3% [95% CI, 8.7%-9.9%] owning the home) or not living with a partner (13.2% [95% CI, 12.3%-14.3%] vs 9.2% [95% CI, 8.5%-9.8%] living with a partner) increased the likelihood of advanced CKM stages in female but not male participants.Conclusions and RelevanceIn this cross-sectional study, disparities in the prevalence of CKM stages by SDOH, particularly family income, food security, and employment, with notable sex differences, were observed in US adults. These findings highlight the need to address inequities in CKM syndrome through targeted interventions.

Semaglutide Eligibility Across All Current Indications for US Adults

This cross-sectional study uses National Health and Nutrition Examination Survey data to examine the number of US adults eligible for semaglutide across all current indications.

Association between periodontitis and cardiometabolic index (CMI): a study from NHANES 2009–2014

AbstractCardiometabolic index (CMI) is a novel anthropometric metric that integrates lipid and adiposity characteristics. The correlation between periodontitis development and CMI is ambiguous. The objective of this study was to establish the association between CMI and periodontitis by analyzing data from the NHANES (National Health and Nutrition Examination Survey) database. A cross-sectional study was conducted on a cohort of 6188 people selected from the NHANES database, covering the period from 2009 to 2014. The study employed multivariate logistic regression to examine the independent correlation between CMI and periodontitis. Subgroup data were analyzed and interaction tests were conducted to assess the impact of variables on the correlation between CMI and periodontitis. The CMI index was significantly and positively associated with the presence of periodontitis (β = 0.03, 95%CI(0.01, 0.05), p = 0.0092). In addition, a U-shaped relationship was found between CMI index and periodontitis severity in an older American population (65 < = age < = 80, with a folding point of 1.44, p = 0.008). This study demonstrates a significant correlation between CMI and periodontitis, positioning CMI as a crucial indicator for assessing periodontal health. Future efforts should prioritize oral hygiene interventions for patients with elevated CMI levels to facilitate early intervention and enhance overall health outcomes.

Association between serum Klotho and the prevalence of osteoarthritis: A cross-sectional study from NHANES 2007–2016

Background Osteoarthritis (OA) is a degenerative joint disease prevalent in the elderly. Currently, the relationship between the senescence inhibitor Klotho and OA remains unclear. This study investigated the relationship between serum soluble Klotho (S-Klotho) and OA. Methods This cross-sectional study was based on the 2007–2016 National Health and Nutrition Examination Survey (NHANES). Three multifactorial logistic regression models were constructed to assess the association between serum Klotho and OA. Restricted cubic spline (RCS) curves were further used to assess whether there was a nonlinear relationship between serum Klotho and OA. Finally, stratified analyses and interaction tests were used to evaluate the association’s stability. To further investigate the relationship between serum Klotho and OA, we recruited 107 patients for analysis at the First Affiliated Hospital of Guangxi Medical University. Results The final 8,918 participants included in this study comprised 50.55% females and 49.45% males, with 18.10% of participants suffering from OA and a mean S-Klotho level of 846.41 (5.61) pg/ml. All three logistic regression models observed a negative association between continuous S-Klotho and OA risk. When S-Klotho was categorized into tertiles, the fully adjusted model showed that participants in the third tertile had a 17% lower risk of OA than those in the first tertile (OR = 0.83, 95% CI: 0.70, 0.99, P = 0.035). The RCS curves showed a linear negative association between S-Klotho and the incidence of OA (P for overall = 0.025; P for non-linearity = 0.667). Further subgroup analyses and interaction tests suggested that the negative association between S-Klotho and OA remained stable in different conditions. Research conducted in China has shown that the negative correlation between serum Klotho levels and the prevalence of OA remains evident among Chinese individuals (OR: 0.77, 95% CI: 0.66, 0.90, P<0.001). Conclusion Our study suggests that elevated levels of the senescence inhibitor S-Klotho may be a potential protective factor for OA, which may provide new insights into the diagnosis and treatment of OA.

Chronic systemic inflammation predicts long-term mortality among patients with fatty liver disease: Data from the National Health and Nutrition Examination Survey 2007–2018

Background Low-grade systemic inflammation (SI) in patients with fatty liver disease (FLD) is an important hallmark of disease onset and progression. This study aims to evaluate the prognostic significance of novel SI markers in FLD. Methods This was a retrospective cohort study. We included adult patients with FLD with complete data and analyzed the association between chronic SI and long-term mortality in patients with FLD. Systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were evaluated based on peripheral blood counts and FLD was determined by the Fatty Liver Index. Results A total of 5497 patients with FLD were included in the final analysis. SII and PIV (but not SIRI) were found to be associated with all-cause and cardiovascular mortality in univariate analysis. Multivariate Cox regression analysis and KM analysis demonstrated that SII and PIV were associated with all-cause mortality, with SII showing a nonlinear correlation in RCS. PIV (but not SII) was associated with the cardiovascular-related survival probability over time. Stratified analysis indicated that the positive correlation between SII and PIV and all-cause mortality was not altered by subgroups. Conclusions SII and PIV are strongly and consistently associated with all-cause mortality in patients with FLD, with PIV potentially showing a closer association with cardiovascular mortality.

Spatial Clustering of Pregnancy Wastage and its Determinants in Manipur: Evidence from National Family Health Surveys

Spatial Clustering of Pregnancy Wastage and its Determinants in Manipur: Evidence from National Family Health Surveys

Early sexual debut and pregnancy termination: uncovering the link among sexually active young women in 23 sub-Saharan African countries

Abstract Background Unplanned pregnancy could be a socio-economic burden for many young women in sub-Saharan Africa (SSA) which often leads to pregnancy termination. The role of age at sexual debut in pregnancy termination in countries with lower income remains unknown. Hence, this study examines the association between age at sexual debut and pregnancy termination among sexually active young women between the ages of 15 -24 in 23 SSA countries. Methods Cross-sectional secondary datasets from the most recent Demographic and Health Survey conducted in 23 countries in SSA conducted between 2010 and 2018 among 34,343 sexually active young women were analysed using bivariate and multivariable logistic regression to examine the association between age at sexual debut and pregnancy termination with statistical significance of p < 0.05. Results The pooled prevalence of pregnancy termination among sexually active young women in SSA was 11.00%. Higher odds of pregnancy termination were found among those who had early sexual debut (below 16 years) [(aOR = 1.34, 95% CI = (1.22–1.48)] compared to those who had late sexual debut. Furthermore, those who were exposed to mass media [(aOR = 1.29, 95% CI = (1.16–1.43)] were more likely to report pregnancy termination compared to those who were not exposed. On the other hand, those residing in rural areas and those within the richest wealth index were associated with lower odds of pregnancy termination. Conclusion The study concluded that early sexual debut of sexually active young women in SSA was significantly associated with pregnancy termination. Mass media exposure was found to be a risk factor for pregnancy termination whilst residing in rural areas, and those within the richest wealth index were protective factors. Interventions should be designed to target young women with early sexual debut to provide comprehensive sexual and reproductive health education to enable them to make informed decisions on pregnancy termination.

Emerging socioeconomic correlates of loneliness. Evidence from the Barcelona Health Survey 2021

Abstract Purpose Recent evidence shows that loneliness is associated with socioeconomic factors. However, studies often focus on traditional socioeconomic indicators (income, occupation, educational level) only, disregarding other important socioeconomic determinants, such as job insecurity, housing conditions or material deprivation. Therefore, we analyse the association of a broad range of socioeconomic indicators with loneliness. Moreover, we investigate potential age and gender differences in this relationship. Methods We used cross-sectional data from the Barcelona Health Survey 2021, representative of the population of Barcelona (Spain). Individuals over the age of 14 were selected (n = 3,337). The outcome was a loneliness score based on 4 items of the UCLA scale. Loneliness was regressed on a series of sociodemographic and emerging socioeconomic correlates. Linear regression models were fitted, and potential age and gender moderation effects were tested by means of two-way interactions. Results Job insecurity and precarity-related factors, such as having a temporary job or working without a contract, material deprivation and financial difficulties, as well as poor housing conditions and facing housing insecurity were associated with increased loneliness levels. While the association between loneliness and precarity-related factors is stronger among younger individuals, material deprivation is associated with increased loneliness among older workers and women. Conclusion Beyond sociodemographic individual characteristics, socioeconomic factors are strongly associated with loneliness levels in the population. Findings support the relevance of broadening the scope of socioeconomic indicators, assessing both material conditions as well as perceived insecurity.

Socioeconomic inequalities in high-risk fertility behaviour among Nigerian women: A non-experimental population-based study

Background High-risk fertility behaviour (HRFB) has adverse health, social and economic effects on women. An understanding of socioeconomic inequalities is needed to design effective interventions targeted to lower maternal morbidity and mortality due to HRFB. Objectives The objective was to quantify socioeconomic inequalities in HRFB among Nigerian women. Design This was a cross-section study that used population-based data. Methods A sample of 21,792 Nigerian women aged 15–49 years from the 2018 Nigeria Demographic Health Survey was analyzed. Percentage was employed in univariate analysis. In addition, concentration index was used to assess the extent of inequalities in HRFB. This was further decomposed to ascertain the explanatory components’ relative contributions to the socioeconomic inequalities in HRFB. Results The weighted prevalence of HRFB (63.5%; 95% CI: 62.6–64.4%), included <18 years at childbirth (4.9%; 95% CI:4.5–5.3%), >34 years at childbirth (18.3%; 95% CI: 17.6–19.0%), >3 children birth order (49.6%; 95% CI: 48.7–50.5%) and <24 months at preceding birth interval (17.0% 95% CI: 16.3–17.6%) were estimated. Education (Contri: 50.3997%, Ec: 0.2771), wealth (Contri: 27.2811%, Ec: 0.2665), socioeconomic disadvantaged (Contri: 14.9163%, Ec: -0.0996), religion (Contri: 13.8636%, Ec: -0.0496), region (Contri: 11.1724%, Ec: 0.0711), partner education (Contri: 7.1351%, Ec: 0.2138), media use (Contri: 4.5064%, Ec: 0.1449) and family motility (Contri: 3.7890%, Ec: -0.0281) were positive contributors to HRFBs among Nigerian women. However, age (Contri: -14.6237, Ec: 0.0089) and history of contraceptive use (Contri: -8.7723, Ec: -0.2094) were negative contributors to HRFBs among women of reproductive age in Nigeria. Conclusion Women who have low socioeconomic level reported higher prevalence of HRFB. Targeted interventions are required to lower HRFB among Nigerian women from poor households and with no formal education. Women should get counselling and assistance from healthcare and educational institutions to help them adopt healthy sexual and reproductive practices.

Prevention of frailty in relation with social out-of-home activities in older adults: results from the Survey of Health, Ageing, and Retirement in Europe.

Out-of-home mobility and social participation have been identified as resources to postpone frailty. We aim to examine the mediating role and specific contribution of social out-of-home activities in frailty prevention. Data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) waves six (w6), seven (w7), and eight (w8) were used. Frailty was measured with the SHARE version of the Edmonton Frail Scale (EFS) with frailty states fit, pre-fail and frail. First, a mediation model with 13,456 fit participants aged ≥ 50years in w6 was specified with social network size, loneliness (UCLA3-Item Loneliness Scale), and lack of motivation (EURO-D) as predictors and number of performed social out-of-home activities in w7 as mediator variable on EFS-scores in w8. Age, education, gender, cohabitation, widowhood, urban environment, and country served as covariates. Second, we investigated the association of increasing social out-of-home activities from w6 to w7 with change in EFS-score from w6 to w8 using a linear mixed model with 17,439 participants in all frailty states. Direct effects of loneliness (w6) and lack of motivation (w6) on EFS-scores (w8) were partially mediated by social out-of-home activities (loneliness ß = 0.005; 95% CI = 0.003-0.008) and (lack of motivation ß = 0.014; 95% CI = 0.009-0.019). The linear mixed model revealed a significant effect of increasing social out-of-home activities (w6-w7) on reduction of EFS-scores (w8) (ß = - 0.21; 95% CI = - 0.29-0.04; p < 0.001). Social out-of-home activities appear to play a crucial role in frailty prevention, which could be used for future interventions.

Patient-centered medical homes and vision care for children: a cross-sectional analysis with data from the national survey of children's health 2018-2019.

Vision screening as part of well-child visits is recommended annually for US children 3 to 6 years. However, 63% of children do not get a vision screening in well-child visits. The Patient-Centered Medical Home (PCMH) improves the receipt of preventive care visits in other medical specialties but it is unknown if it improves receipt of vision screening. The objective of this study is to determine whether caregiver-reported receipt of care in a PCMH is associated with receiving a vision screening test in a well-child visit for children 3 to 6 years in a pediatrician/general doctor's office ('primary care'). Population-based data for US children aged 3 to 6 years was derived from the National Survey of Children's Health (2018-2019). Children were excluded if they did not have a well-child visit in the previous 12 months. The primary exposure was receipt of care in a PCMH ('PCMH care'), and the primary outcome was receipt of a vision screening in primary care. Adjusted odds ratios (aOR) and predicted probabilities were computed for children with and without PCMH care. Among 9,587 children with well-child visits, 4,984 (50.9%) were males. There were 1,107 (23.3%) Hispanic, 6704 (52.8%) White/Non-Hispanic and 545 (11.8%) Black/Non-Hispanic children. There were 5,482 (51.8%) children who received PCMH care. Of those with PCMH care, 2,629 (52.2%) received a vision screening in primary care. Those with PCMH care (52.2%) had a higher odds of receiving a vision screening (aOR, 1.31; 95% CI 1.11, 1.55) in primary care compared to children without PCMH care (42.8%). The predicted probability of vision screening in primary care was 50.8% (95% CI 48.2, 53.5) for children that received PCMH care, and 44.3% (95% CI 41.3, 47.3) without PCMH care. Caregiver-reported receipt of PCMH care was associated with a greater likelihood of vision screening for children 3 to 6 years in a well-child visit. Further studies are needed to understand the mechanisms through which PCMH care contributes to the greater odds of vision screening in primary care to inform the creation of strategic interventions to prevent vision loss and its long-term implications.

Association of dietary niacin intake with all-cause and cardiovascular mortality: National Health and Nutrition Examination Survey (NHANES) 2003-2018.

The long-term health impacts of niacin are still debated, and the association between dietary niacin and mortality risk in populations hasn't been extensively explored. This study included 26,746 US adults aged 20 years or older from the National Health and Nutrition Examination Survey 2003-2018, with a median follow-up of 9.17 years. During this period, there were 3,551 all-cause deaths, including 1,096 cardiovascular deaths. Cox models were used to compare hazard ratios (HRs) for mortality among participants grouped into different dietary niacin intake quartiles. Participants with the highest dietary niacin intake had a lower risk of all-cause mortality (HR 0.74, 95%CI 0.63-0.86) compared to those in the lowest intake quartile. For cardiovascular mortality, the HR was 0.73 (95%CI 0.57-0.95) in the highest niacin intake quartile. A dose-response relationship was revealed between dietary niacin intake and mortality by restricted cubic spline. Subgroup analysis showed a significant interaction between dietary niacin intake and diabetes concerning all-cause mortality (P = 0.046). In this population-based cohort study, higher dietary niacin intake correlates with lower risk of all-cause and cardiovascular mortality among US adults. The influence of niacin intake on all-cause mortality appears to be more significant in non-diabetic individuals compared to those with diabetes.

Prevalence of infertility and its association with intimate partner violence in Tanzania: Findings from the 2022 Demographic and Health Survey.

We first estimated the prevalence of primary and secondary infertility in Tanzania and then examined its association with recent experiences of intimate partner violence (IPV). We used cross-sectional data from the Tanzania Demographic and Health Survey 2022 and included 6894 women aged 20-49 years to estimate the prevalence of primary and secondary infertility. In a subset of 2802 partnered women who were surveyed about physical, emotional, and sexual IPV, we also examined the association of any form of IPV in the 12 months prior to the survey with both primary and secondary infertility using multivariable logistic regression. The prevalence of primary infertility was 1.8% (95% confidence interval [CI]: 1.0, 3.1) and secondary infertility was 15.4% (95% CI: 2.1, 61.0). Primary infertility was higher in urban areas (1.9%) compared to rural areas (1.7%) (P < 0.001). Over one-third (37.9%) of the women who were surveyed concerning IPV reported experiencing at least one form of IPV in the 12 months prior to the survey. Almost one-fifth (18.3%) of women with secondary infertility had experienced at least one form of violence in the past 12 months prior to the survey, compared to 1.5% with primary infertility (P = 0.656). Women with secondary infertility were 1.58 times more likely to have experienced any form of IPV (aOR = 1.58, 95% CI: 1.08, 2.33). In Tanzania, the high prevalences of both infertility and IPV and the link between the two warrants the need for strengthening infertility care and treatment and support for women experiencing IPV.

The Association between the Type of Mental Health Treatment Received, Metropolitan Status and Gender.

The purpose of this study is to examine the relationship between the type of mental health care received and metropolitan status. We combined data from the National Survey for Drug Use and Health (NSDUH) to examine mental health treatment. We grouped participants by metropolitan status and receipt of mental health treatment. We conducted a logistic regression using interaction terms to compare the likelihood of receiving inpatient and/or outpatient treatment for mental health, relative to prescription medication alone. There was an association between the type of mental health treatment received and metropolitan status. For women, living outside a large metropolitan area was associated with a higher likelihood of receiving only prescription medication (p < 0.001). Policy makers may use these results to consider ways to increase access to care, including increasing funding for behavioral health or recruitment incentives for specialists.

Insufficient capacity to cope with stressors decreases dietary quality in females.

Previous studies had found the effects of stress on eating behaviors. The aim of this study was to explore the effects of perceived stress on dietary quality by sexes in Chinese adults. The study population consisted of individuals aged 18 to 59 years participating in the China Health and Nutrition Survey. Perceived stress levels were measured using the 10-item Perceived Stress Scale (PSS-10), with scores ranging from 0 to 40. Dietary quality was evaluated by Chinese Dietary Guidelines Index (CDGI) ranging 0-110. Using a two-level mixed effects model with community as level 2 and individual as level 1, the study analyzed the impact of PSS-10 scores on CDGI. Additionally, a two-level mixed effects structural equation model was employed to explore the effects of distress factor scores and coping stressor factor scores on dietary quality among different sexes within the population. This study involved in 2515 males and 3165 females, and the average age was 45.9 ± 9.6.The PSS-10 score and CDGI were 14.6 ± 5.1 and 44.8 ± 11.6, separately. After adjusting for confounders, there were no effects of PSS-10 score, distress factor score, and coping stressors factor score on CDGI in males. After adjusting for confounders, CDGI in the highest tertile of PSS-10 score group was 1.64 lower than that in the lowest tertile group in females(P = 0.001). The distress factor score was not associated with CDGI (standardized β=-0.164, P = 0.488), while the coping with stressors factor score was significantly negative with CDGI (standardized β=-0.834, P < 0.001) in females. CDGI in the highest tertile of coping with stressors factor score group was 4.36 lower than that in the lowest tertile group (P < 0.0001). There was no association between perceived stress and dietary quality in adult males. The perceived stress, especially the insufficient capacity to cope with stressors, was negatively associated with dietary quality in adult females.

Moderation of sex in the Association between School Bullying Behaviors and problematic gaming among Chinese adolescents: a cross-sectional study.

Problematic gaming (PG) is a serious issue among adolescents worldwide, and there is evidence suggesting that school bullying behaviors may be associated with increased rates of PG. This study aimed to examine the associations between school bullying behaviors and PG among adolescents, with a focus on sex effects. A total of 20,197 participants were recruited from the 2023 School-based Chinese Adolescents Health Survey. Information about school bullying behaviors and PG was measured. Sampling weights were utilized to estimate the prevalence, and weighted logistic regression models were executed. Stratified analyses by sex were performed. Among Chinese adolescents, the weighted prevalence of PG was 4.2%, 8.1% were identified as victims, 1.8% as bullies, and 3.4% as bully-victims. A higher frequency of school bullying behaviors corresponds to a higher prevalence of PG. After adjusting for covariates, victims (AOR = 1.34, 95% CI = 1.03-1.73), bullies (AOR = 2.08, 95% CI = 1.39-3.11), and bully-victims (AOR = 2.75, 95% CI = 2.09-3.61) were associated with PG. Moreover, the severity of PG tended to increase with the number of involved in school bullying behaviors. The interaction terms of bully-victims and sex were significant. Further stratified analyses by sex indicated that the association of school bullying behaviors with PG was stronger for females than males, especially those identified as bully-victims. School bullying behaviors are associated with PG among adolescents, with a stronger association found in female adolescents, particularly those identified as bully-victims. These findings suggest that implementing prevention and control measures for school bullying could help reduce PG among adolescents.

Prevalence of Child Fever, Acute Respiratory Infection, and Diarrhea and Their Risk Factors in Sierra Leone

Sierra Leone has the fourth-highest child mortality rate in Sub-Saharan Africa. This retrospective study aimed to estimate the nationwide prevalence of fever, acute respiratory infection (ARI), and diarrhea in children under 5 years in Sierra Leone, and to identify the risk factors associated with these diseases. We extracted patient information from the 2019 Sierra Leone Demographic and Health Survey data. Data were analyzed using multivariate logistic regression. In total, 8659, 8652, and 8650 children were included in the analyses of fever, ARI, and diarrhea, respectively. The analysis revealed that the nationwide prevalence rates of fever, ARI, and diarrhea were 16.8%, 14.2%, and 7.2%, respectively. Children aged 12–23 months were found to be the most susceptible. Compared to children consuming unimproved water, the highest prevalence rates of fever, ARI, and diarrhea were observed among children residing in households with tube wells or boreholes. The adjusted odds ratio for diarrhea prevalence among children drinking water from household tube wells or boreholes was 1.47 (95% confidence interval: 1.17–1.84, p &lt; 0.001). This study has several limitations, including recall bias due to parental reporting. We suspect that the diseases may be associated with potential water contamination in tube wells or boreholes. We recommend national-level periodic inspections of water quality and community-level education on water supply management.